Page 27 - Personality disorders and insecure attachment among adolescents

may be a developmental phase in which opportunities for change in personality pathology are greater, under the right conditions, than in adulthood. Furthermore, clinical impression suggests that joint problem definition between parents and adolescents, willingness to change and parental support, together with a relatively stable and safe home environment, are crucial to the treatment’s success. These factors may be of less crucial importance in adults. If parents are not able to reflect on family dynamics and are critical towards treatment offers, the treatment has fewer chances of success. Unfortunately, in this study no data were collected regarding the role of parents. Future research should examine the effect of the role of parents on the treatment outcome in adolescents with personality disorders. It is necessary to discuss the strengths and limitations of this study. One strength was the inclusion of a high risk adolescent sample with comorbidity that is rarely examined. The first limitation is that only part of the patients that were included in this study could be followed from the start until the end of treatment. Information about the patients we did not follow is scarce. Initially, however, these patients did not differ in number and type of personality disorders. The shorter duration of treatment suggests that this group either profited less from treatment than those who completed it or improved enough so as not wish to continue treatment. In this study, possible causal mechanisms for the premature termination of therapy amongst adolescents with personality disorders remained unclear. The second shortcoming of this study was that the Axis I disorders were left out due to the practical consideration of not overloading patients with assessment instruments. Finally, the third limitation is that, due to the research design, the extent to which treatment played a role in the positive outcome and which parts of the programme may have contributed remains unknown. Research on the outcome of treatment for adolescents with personality disorders other than borderline personality disorder or a combination of personality disorders is scarce (Weisz et al., 2013). Examining the specific mechanisms of change in the different treatments for adolescents with personality disorders is thus important. The treatment examined in this pilot study is promising, although essential questions remain unanswered. Replication is necessary in order to determine whether the results were based on coincidence or not. References Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment Studies with Borderline Patients: A Review. Harvard Review of Psychiatry, 12(2), 94-104. 23